Behavioral health denial & prior-auth readiness self-check
Eight quick questions. A prioritized operational-risk profile based on your answers — never a fabricated revenue-leakage dollar figure. Use this to see where process leaks before you book a sales call; use rcm.today when you want cost-to-collect arithmetic.
Last reviewed against the FDA label and SPRAVATO REMS programme materials on .
What this is (and is not)
This tool reflects your selections back as risk ordering across prior-auth, 908xx coding, eligibility/carve-outs, and measurement. It does not audit your claims, predict recovered revenue, or replace a Revenue Diagnostic. It collects no practice name, location, or free text. For cents-per-dollar collection cost, go to rcm.today/cost-to-collect (opens in a new tab).
Behavioral health denial & prior-auth readiness self-check
Gate-free. No practice name, no location, no dollar fields. Answers update a prioritized operational-risk profile instantly — never a revenue-leakage guess. For the arithmetic on what billing costs you in dollars, use the neutral calculator on rcm.today.
Readiness summary
Based on your answers, your biggest likely leaks are Measurement (clean claim / days in A/R) and Prior-auth & re-authorization.
Prioritized risk areas
- Common leakMeasurement (clean claim / days in A/R)
You cannot prioritize what you have not measured. First-pass clean claim rate and days in A/R are the two numbers that tell you whether denials and follow-up are under control.
Next step: Pull both reports from your practice-management system for the last 90 days. For neutral definitions and a cost-to-collect view, use the free tools on rcm.today (benchmarks + cost-to-collect calculator).
- Needs attentionPrior-auth & re-authorization
Spreadsheet or EHR-reminder tracking can work at small volume, but it often misses payer-specific re-auth windows and multi-payer behavioral panels. Occasional denials are the early signal.
Next step: Add a weekly re-auth queue: every active ongoing therapy case with fewer than 3 authorized sessions remaining, and every psychiatry case approaching plan-year visit caps.
- Needs attention908xx coding
Some uncertainty on 908xx add-ons usually means time documentation or interactive-complexity criteria are not applied consistently across providers.
Next step: Audit 20 recent therapy and E/M+psychotherapy notes against the billed 908xx family (including any interactive-complexity add-on). Fix documentation templates before chasing more volume.
- Needs attentionEligibility & BH carve-outs
“Usually” checked still leaves room for plan changes, exhausted benefits, and carve-out mismatches on the visits that matter most.
Next step: Require eligibility + behavioral-benefit confirmation before the visit (not only at check-in). Flag plans where BH is administered separately from medical benefits.
Guidance
First-pass clean claim rate is unknown
Without this rate you cannot tell whether denials are a front-end process problem or an unavoidable payer mix issue.
Next step: Run a 90-day first-pass clean claim report from your PM system. Better-performer framing often targets ≥95% — confirm the definition matches how you want to manage, and use rcm.today benchmarks for neutral context.
Days in A/R is unknown
Days in A/R is the simplest cash-flow health check. Not knowing it usually means follow-up work is reactive.
Next step: Calculate total A/R ÷ average daily charges (rolling 90 days, excluding credit balances). Compare trend month-over-month before comparing to any external benchmark.
This reflects your own answers, not an audit of your data. It is a starting point for where to look, not a diagnosis.
After you have a risk ordering
- Pull the reports the result names (denials by reason, first-pass clean claim, days in A/R, re-auth queue).
- Read the vertical detail on behavioral health billing.
- If you want a human to look at real data, book a Revenue Diagnostic — including the possibility that you do not need us.
- Keep quantitative cost math on rcm.today (opens in a new tab).
Book a Revenue Diagnostic
Bring the self-check result if you want — it is safe to paste (no PHI). A person at AdvancedCare will review your actual denial and A/R data and tell you what they see.
Get in touch
Sources
- AMA prior authorization physician survey (2024) (opens in a new tab) — American Medical Association
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) (opens in a new tab) — Centers for Medicare & Medicaid Services
- CPT psychotherapy and psychiatry coding overview (AMA) (opens in a new tab) — American Medical Association
- rcm.today cost-to-collect calculator (neutral arithmetic) (opens in a new tab) — AdvancedCare USA Inc. (rcm.today)
Common questions
- Why won’t this tool estimate dollars of leakage?
- Vendor-owned dollar calculators on sales pages are structurally incentivized to scare. Quantitative cost-to-collect lives on rcm.today with disclosed ownership and sourced constants. This tool only orders operational risk from your answers.
- Is my data stored?
- Selections stay in your browser for the live result. There is no account, no upload, and no email gate. Copy-result is plain text of selections and risk ordering only.
- Does a “leak” label mean we must outsource billing?
- No. It means that answer pattern is associated with common outpatient BH process failures. Fix in-house, hybrid, or outsourced — the diagnostic is for scope, not a forced product.
Last reviewed against the FDA label and SPRAVATO REMS programme materials on .
Every regulatory or industry claim on this page is cited with a publisher and link. Product capabilities marked as varying are confirmed during a Revenue Diagnostic — we will not invent accuracy percentages or client testimonials.